Leonard J. Haas

Psychological safety of a multiple channel cochlear implant device: psychological aspects of a clinical trial

Fifty-three deaf patients were screened psychologically and medically for suitability to receive an intracochlear implant. After initial screening for psychological normalcy, candidates were assessed again 1 year postimplant. Isolated deleterious psychological effects were found, and certain aspects of psychological functioning were enhanced. Overall evidence suggests that the implant is not psychologically damaging.

Expanding Mental Health Services to Older High-Utilizing HMO Patients: A Pilot Study

Background: Expanded mental health benefits were offered to older HMO patients who were high medical utilizers. Outcomes of interest were use of services, subjective well-being, and psychopathology. Methods: Sixty-nine (25 male, 44 female) patients age 55 or above seeking frequent outpatient medical care completed the SF-36 health survey and the revised Symptom Check List (SCL-90-R). Patients were assigned to usual care, health education, or expanded mental health benefit conditions. Results: Patients showed high initial levels of psychopathology and distress. Over the 6 months of the study, patients in the expanded benefits group made a mean of 11.5 visits to mental health professionals versus a mean of 3.4 visits by usual care patients. Patients in the expanded benefits group showed significant improvement in SF-36 General Health and Mental Health well-being scores. Patients in the health education group showed no improvement. Patients in the usual care group showed improvements in Vitality scores. Psychopathology summary scores showed improvement for both usual care and enhanced benefit groups. Conclusions: Mental health treatment may improve well-being and reduce psychopathology in older high-utilizing patients. Creativity will be needed in expanding access to mental health services for this population.

Selected Behavioral and Psychiatric Problems

The disorders discussed in this chapter comprise a diverse group of problems, appearing on axes I and II of the Diagnostic and Statistical Manual of Mental Disorders,4th edition (DSM-IV).1 They require different diagnostic and management strategies and represent differing degrees of prevalence in the typical family physician’ s practice. However, they have several aspects in common. First, patients with any of the disorders discussed in this chapter require careful attention to history and a sophisticated understanding of communication styles and interpersonal needs. Each condition demands extraordinary efforts from the family physician to maintain a productive doctor-patient relationship. Second, major progress has occurred in recent years regarding the genetic and neurobiologie contributions to etiology of each of these problems. Third, the diagnostic boundaries between these and other conditions are recognized as less distinct than once thought. Finally, medical management of each is becoming increasingly directed at specific symptom complexes, independent of diagnosis.